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A Rigorous Mind Meets Her Yielding Body: Intellectual Life and Meaning-Making in Wit

Ellen A. Foster, PhD
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From Clarion University–Venango Campus, Oil City, PA 16301.

Note: An earlier version of this paper was delivered at The Patient: An International Symposium, co-hosted by Bucknell University and the Geisinger Medical System, Lewisburg, Pennsylvania, in October 2006.

Acknowledgments: The author thanks the discussants at The Patient: An International Symposium for their encouraging responses, which benefitted the further refinement of my ideas regarding Wit and meaning-making.

Requests for Single Reprints: Ellen A. Foster, PhD, Department of English, Clarion University–Venango Campus, 1801 West First Street, Oil City, PA 16301.

Ann Intern Med. 2007;147(5):353-356. doi:10.7326/0003-4819-147-5-200709040-00024
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Patients, their family and friends, and medical professionals often consider the experiences of illness (and particularly terminal illness) as primarily physical, emotional, and spiritual. This is no doubt true, but for at least some segment of the patient population, their intellects, or intellectual lives, offer ways to frame and confront the complexity of the experiences of illness and dying, to consider the meaning of their lives, and to remember that they are more than their diseases. For these patients, the habits of the life of the mind, a life centered on gaining and sharing knowledge, are familiar and comfortable: They are accustomed to defining, analyzing, and assessing complex situations; they have a faith in knowledge and their intellectual abilities. Confronted with the illness and mortality of the body, such patients may find that these intellectual frameworks offer a way to make sense of these new experiences, to integrate them within their bodies of knowledge.


cancer ; emotion

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Wit and the Art of Medicine
Posted on October 2, 2007
Harvey Ouzts
Conflict of Interest: None Declared

TO THE EDITOR: Ellen Foster reviewed how intellectual wit is featured in the film and play Wit written by Margaret Edson (1). Wit is a beautiful and realistic play about a woman with cancer and should be required reading or viewing by all of the medical profession. But, by expanding the definition of wit, we can learn more lessons than those Edson presents especially if we compare wit to the art of medicine.

The concept of wit presented by the play Wit comes from the metaphysical poetry of John Donne (1572-1631). In those poems, wit is the presentation of ideas by the use of metaphors which are often complex, paradoxical and ambiguous. The play shows how intellectual wit of the protagonist sustains her during the early phases of chemotherapy for her fatal ovarian cancer. However, the play and Foster make it very clear that intellectual wit fails to provide comfort for death, and does not substitute for kindness and simplicity. The most powerful scene is when Vivian rejects John Donne's poetry but accepts a children's story The Runaway Bunny to be read to her on her death bed (2).

The concept of wit was a favorite topic of the eighteenth-century writers and it generally did not refer to the abstract and convoluted wit of John Donne. The most famous description of wit was by Alexander Pope in his An Essay on Criticism (3): "True wit is nature to advantage dressed What oft was thought, but ne'er so well expressed" (297-8). Wit is the ability to communicate an idea in a way that is unique, engaging, and sensitive and often with metaphors but it ought not to be abstruse. In medicine this is the art of communicating information to the patient which establishes a connection of confidence. Wit is a creative process that is a "right brain activity" and, according to, Paul Torrance (4) the first step is to be sensitive to a gap in knowledge and then know how to fill that gap.

Another physician, John Locke, writes in An Essay Concerning Human Understanding (1689) that wit involves "metaphor and allusion" and is "acceptable to all people because its beauty appears at first sight"(5). While Locke considered wit separate from judgment Pope did not. However, most of us have seen colleagues that have wit without judgment and vice versa. In Tristram Shandy, Laurence Sterne writes that "wit and judgment are like two knobs on the back of a chair" (6), separate but connected. For the physician, wit is the art of medicine, while judgment is more related to the science of medicine.

To apply this principle let us compare the conversation of Kelekian, the attending, and Jason, the oncology fellow, from the play to a more appropriate comment that I made up.

Kelekian: "The tumor is spreading very quickly, and this treatment is very


Jason: "The intercellular regulatory mechanisms"”especially for

proliferation and differentiation"”the malignant neoplasia just

don't get it."

More appropriate: "We are going to give you drugs that are

poisonous to cells. The cancer cells are greedy and will eat

the poison much faster and hopefully will die. But, good cells

like hair and white cells that fight infection will also be damaged.

In the end the cancer will win but we will fight it as long as we

should. We will also try to do everything to prevent pain and

preserve your dignity."

Wit, like the art of medicine, may be difficult to define but we can easily recognize it. The eighteenth-century Scottish philosopher David Hume says it well: "it may not be easy to define; but it is easy surely to determine that it is a quality immediately agreeable to others, and communicating, on its first appearance, a lively joy and satisfaction to every one "¦" (7).

Harvey G. Ouzts MD Athens, Georgia 30606


1. Foster Ellen A. A Rigorous Mind Meets Her Yielding Body: Intellectual Life and Meaning-Making in Wit. Ann Intern Med. 2007; 147:353-56.

] 2. Edson Margaret. W;t. New York: Faber and Faber, 1999.

3. Pope Alexander. An Essay on Criticism. Ed. Raymond Southall. London: Macdonald and Evans. 1973.

4. Sanders Donald A and Sanders Judith A. Teaching Creativity Through Metaphor. New York: Longman, 1984

5. Locke John. Concerning Human Understanding. Britannica Great Books of The Western World. Chicago: Encyclopedia Britannica.1978.

6. Sterne Laurence. The Life and Opinions of Tristram Shandy, Gentleman. New York: The Modern Library, 2004.

7. Hume David. Enquiries Concerning The Human Understanding And Concerning The Principles of Morals. Ed. LA Selby-Bigge. Oxford: Clarendon. 1902.

Conflict of Interest:

None declared

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